title: Non-alcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children?
abstract: OBJECTIVE
  To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome, and if liver B-ultrasound can be used for its diagnosis.
  
  
  METHODS
  We classified 861 obese children (6-16 years old) into three subgroups: group 0 (normal liver in ultrasound and normal transaminases); group 1 (fatty liver in ultrasound and normal transaminases); and group 2 (fatty liver in ultrasound and elevated transaminases). We measured the body mass index, waist and hip circumference, blood pressure, fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), lipid profile and transaminases in all the participants. The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination.
  
  
  RESULTS
  Among the 861 obese children, 587 (68.18%) were classified as having NAFLD, and 221 (25.67%) as having MS. The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587), which was much higher than that in non-NAFLD group (group 0, 12.04%) (P < 0.01). There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05). The incidence of NAFLD in MS patients was 84.61% (187/221), which was significantly higher than that of hypertension (57.46%, 127/221) and glucose metabolic anomalies (22.62%, 50/221), and almost equal to the prevalence of dyslipidemia (89.14%, 197/221). Based on the B-ultrasound scales, the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR): 2.18, 95% confidence interval (95% CI): 1.27-3.75], dyslipidemia (OR: 7.99, 95% CI: 4.34-14.73), impaired fasting glucose (OR: 3.65, 95% CI: 1.04-12.85), and whole MS (OR: 3.77; 95% CI: 1.90-7.47, P < 0.01). The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased.
  
  
  CONCLUSIONS
  NAFLD is not only a liver disease, but also an early mediator that reflects metabolic disorder, and liver B-ultrasound can be a useful tool for MS screening.
authors.affiliation: Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China. fjf68@yahoo.com.cn
authors.forename: Jun-Fen
authors.initials: JF
authors.lastname: Fu
authors.forename: Hong-Bo
authors.initials: HB
authors.lastname: Shi
authors.forename: Li-Rui
authors.initials: LR
authors.lastname: Liu
authors.forename: Ping
authors.initials: P
authors.lastname: Jiang
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Wang
authors.forename: Xi-Yong
authors.initials: XY
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D005234:Fatty Liver / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications*; D014463:Ultrasonography